Obamacare Unanswered Questions
NEW YORK ( MainStreet) On the surface, the Affordable Care Act is a pretty straightforward three point plan:
- Require insurance companies to issue policies to anyone regardless of health,
- Which means healthy Americans have to buy policies too otherwise those insurance companies will go bankrupt,
- So you need subsidies to help people who can't afford the premiums on their own.
Execution is a lot more complicated, and the Affordable Care Act has already started to raise questions about whether it's truly ready to go live. Without meaning to pile on (all right, fully meaning to pile on), here are some of mine:
Will websites really work?
The flagship program of the ACA is its insurance exchange marketplaces, the system for citizens to buy individual policies at group rates. The main place to do that is online.
While the state and federal programs have set up telephone hotlines, almost all information about the ACA directs users first and foremost to the exchange websites like healthcare.gov. They're the face of the program, and it's a little hard to figure out how to get insurance under the ACA offline.
It makes one sort of sense. A website is the perfect vehicle for this kind of transaction. It's centralized, secure, easy to update and able to take consumers from empty handed to insured in just one session.
The problem is, about 20% of America isn't online . While this system will work fantastically for the young and affluent, that's also generally the population that has no trouble finding and getting insurance on its own. The question is, can these websites effectively reach the low income and underserved populations they're meant to serve?
People who can't afford or find health insurance are also the people least likely to have a monthly Internet connection. While some can use the library, and others will dig up the proper phone numbers (largely provided online), on the whole I'm unsure if such a web-forward program will actually reach all of America.
How well will tax credits work for someone who can't pay today?
People who can't afford insurance premiums will get help in the form of tax-based subsidies. In one sense it's a good way to connect people with the money since the IRS already handles that sort of thing, but it also means those checks will go out once per year.
Credits get issued when someone files his taxes, meaning that anyone who qualifies for an ACA subsidy will receive it in one lump sum per year. If you look at things from a big picture perspective the numbers end up looking fine.
But what about someone who needs that money today?
As a general rule, the less money someone makes the closer the person lives to the bone. Someone making a comfortable living can afford to spend money now knowing he'll get it back later, but someone who lives paycheck to paycheck rarely has that luxury. It doesn't matter if the money shows up on April 15 when the rent is due right now.